Background

BACKGROUND Although breast milk fulfills most needs of newborn infants, it is considered a source of cytomegalovirus infection in preterm infants.

Objectives

OBJECTIVE Aim of this study is to confirm that initial administration of native colostrum/breast milk for 5 days does not lead to early virus transmission. For optimal risk assessment, plotting of temporal course of viral load in breast milk is necessary. Correlation between viral load and amount of breast milk should be evaluated.

Methods

PATIENTS AND METHODS The study population consisted of CMV-seropositive mothers and their children born before 32 gestational weeks. Infantile urine and breast milk samples were taken for CMV detection. Breast milk data were collected for statistical analysis.

Results

MAIN RESULTS Breast milk was administered native for the first 5 days of life and afterwards pasteurized until a gestational age of 32 weeks. In one of 3 cases CMV was transmitted early while breast milk was still pasteurized. In this case, virus was not only detectable in breast milk but in maternal sputum. Sputum is another source of infection.

Viral load in breast milk increased after an initial drop until reaching a maximum in week 5.

Correlation between viral load and amount of breast milk was calculated. Due to highly divergent results, no general statement could be made.

Conclusion

CONCLUSION As initial administration of native colostrum/breast milk for 5 days does not seem to result in early virus transmission, indication for pasteurization of breast milk should be strict and administration of native breast milk should be considered.

Background

Neonatal morbidity rates in bilateral renal agenesis are still estimated at 100 % because of respiratory failure. We present the case of an infant, which developed nearly normal pulmonary function despite of bilateral renal agenesis. To our knowledge this is only the second case in literature with similar findings.

Objectives

single patient

Methods

Case-Report

Results

Prenatal sonography at 19 weeks is strongly suspicious for bilateral renal agenesis with severe oligohydramnion. Abortion is discussed, which the parents decide against. At 31 weeks amniotic fluid (AF) is surprisingly presentable. At 34 weeks AF volume is at lower normal range, stomach and urinary bladder are not viewable. Because of PPROM at 35 weeks the child is delivered by cesarean-section. Respiratory stabilization is successful, short-term NO and Sildenafil administration lead to sufficient spontaneous breathing. Postnatal MRT confirms bilateral renal agenesis, but also shows duodenal atresia, small intestine stenosis and caudal regression syndrome, meeting clinical findings (e.g. anal atresia). A horseshoe-kidney obstruction described in fetal MRT equates to "double-bubble-sign". PD is successful.

In repeated multidisciplinary care conferences, however, palliative treatment is decided especially because of the limited prognosis of surgical repair during PD.

Conclusion

Maybe AF removal by swallowing was ineffective due to duodenal atresia and maintained an effectual AF volume. In literature, another theory describes a vascular accident of pelvic arterial supply later in pregnancy resulting in renal agenesis and atresia of pelvic organs – which also fits to our patient.

Our case could help to discuss generally poor fetal prognosis due to bilateral renal agenesis more individually.